Substance Use Disorders: A Path Forward for Michigan

Transcription

1 Substance Use Disorders: A Path Forward for Michigan DEBRA A. PINALS, M.D. MEDICAL DIRECTOR BEHAVIORAL HEALTH AND FORENSIC PROGRAMS MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES

2 Tackling the opiate crisis at the state and local level

3 Drug Poisoning Death Rate per 100,000, by County, Source: CDC NVSS Multiple Cause of Death File, MICHIGAN Michigan s Status: Age-Adjusted Drug Poisoning Death Rate (2014) (Avg. National Rate: 13.5) National Rank in Drug Poisoning Death Rate (2014) Requires ALL Prescribers Receive Appropriate Opioid Prescribing Training Established a Prescription Drug Monitoring Program (PDMP) Requires Pharmacy to Submit Data to PDMP within 24 hours Requires PDMP use by ALL Prescribers PDMP Interoperable with other States State Law Explicitly Allows Syringe Service Programs Permits Distribution of Naloxone by Pharmacists* Permits Third Party Prescriptions of Naloxone (eg. Family member, caregiver) *Under a standing order, collaborative practice agreement, or prescriptive authority. Drug Poisoning Death Rate by State and National (age-adjusted per 100,000 population) Michigan Annual rate of opioid pain reliever prescriptions dispensed by retail pharmacies (per 100 population) Michigan 18.0 per 100K population 16th NO YES [PDMP TTAC State Profiles] YES [CDC Prevention Status Reports] NO [CDC Prevention Status Reports] Source: National Vital Statistics System Source: IMS Health Shares info with 20 states [National Association of Boards of Pharmacy] NO NO YES [Mich. Comp. Laws b] Based on information available as of March 21, 2016

4 Increase in Prescription of 4 Opioids Hydrocodone and Oxycodone prescribing has increased nearly 300% nationwide since 1991 Source:

5 Increase in Heroin Use 5 Heroin use increased approximately 50% from 2005 to 2010 Heroin deaths increased approximately 50% from 2005 to 2010 Source:

6 The State Responds

7 The 2015 Task Force On June 18, 2015, Governor Rick Snyder appointed a task force to address prescription drug and opioid abuse Governor Snyder appointed Lt. Governor Brian Calley to lead this effort Lt. Governor Calley said prescription drug and opioid addiction has quadrupled the number of unintentional drug deaths in our state since 1999 and we must come together to reverse this trend before more Michiganders are hurt.

8 Task Force 8 Recommendations The Task Force report includes 25 primary recommendations and 7 contingent recommendations grouped into the following categories: Prevention Treatment Regulation Policy and Outcomes Enforcement

9 Implementation: Working 9 within and across systems 5 different state agencies are responsible for the implementation of these recommendations: Department of Health and Human Services Department of Licensing and Regulatory Affairs Michigan State Police Attorney General Department of Insurance and Financial Services

10 Prevention 10

11 Prevention 11 Increase drop-off bins Drop-off bins at all Michigan State Police posts throughout the state Many Law enforcement offices, pharmacies, and other locations maintain drop-off bins Maps of locations can be found here: _4118_ ,00.html and here:

12 Prevention 12 Benefits Monitoring Program Medicaid improving "Lock In" program that prevents doctor and pharmacy shopping by locking a beneficiary to one doctor and one pharmacy Health Plan contract language strengthened to increase use of benefits monitoring program Beneficiaries are connected to treatment resources Software improvements are ongoing

13 Prevention 13 Awareness Efforts In July, MDHHS launched a statewide media campaign on You Tube to raise awareness among teens about the health and personal consequences of drug use MDHHS posted a web based campaign "Do Your Part" to prevent prescription drug and opioid abuse. The campaign can be accessed at MDHHS will soon launch a statewide public awareness campaign on dangers of prescription drug abuse

14 Prevention 14 Federal Grant Funded Efforts MDHHS Violence and Injury Division received a $2.25 million grant to combat opioid misuse from the Centers for Disease Control and Prevention (CDC) The CDC grant enable Michigan to: improve data collection and analysis around misuse and overdose; develop a strategy to combat the epidemic; and work with communities to develop opioid overdose prevention programs

15 Prevention 15 Federal Grant Funded Efforts MDHHS is in the second year of a 5-year grant Substance Abuse and Mental Health Services Administration (SAMHSA) grant to prevent prescription drugs opioid abuse among youth and young adults The grant provides eight communities (Macomb, Muskegon, Lake, Mason, Bay, Cass, Genesee and Wayne Counties) resources to integrate evidencebased prevention programming, including Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care settings

16 Treatment 16

17 Treatment 17 Increase access to Naloxone Standing Order legislation to improve access to naloxone to family, friends, and others signed in 2016 Rule promulgation in progress for Standing Order MDHHS provided 5,800 Naloxone kits to first responders along with information on where to access treatment by five Prepaid Inpatient Health Plans (PIHPs)

18 Treatment 18 Increase access to care Medicaid established reimbursement policy regarding Vivitrol in residential treatment services Physicians and non-physician practitioner services related to opioid dependence may be reimbursed through Fee-For-Service Medicaid

19 Treatment Good Samaritan Law The Task Force recommended passing a Good Samaritan law to encourage people to seek medical assistance during an overdose In 2016, Governor Snyder signed Michigan s Good Samaritan law that will protect individuals from criminal liability if they seek medical assistance for an overdose 26

20 Treatment 27 Neo-Natal Abstinence Syndrome Michigan participating in a Policy Academy focused on improving outcomes for pregnant and postpartum women with opioid use disorders and their infants and families who are involved or at risk of being involved with child welfare services MDHHS NAS Project Substance Abuse Prevention and Treatment Block Grant Funding o o Each PIHP region submitted a proposal aimed at reducing the incidence of NAS affected births Involves building relationships with NICUs, Hospitals and other agencies such as CPS

21 Task Force 21 Recommendations Policy and Outcomes Create ongoing Task Force Enforcement Improve the MI Automated Prescription System (MAPS) Increase access to MAPS Increase sanctions

22 Implementation: Process 22 and Direction In 2016, an ongoing Prescription Drug and Opioid Abuse Commission (PDOAC) was established by Executive Order First meeting: December 2016 (Chair: Judge Linda Davis) The Commission will further support implementation of the Task Force s recommendations

23 Legislation 23

24 Legislation 37 On March 23, Governor Snyder and several legislators announced a package of bills to combat opioid and prescription drug abuse Some bills are Task Force recommendations: Bona-fide doctor-patient relationship Licensing of pain clinics Good faith exemption for pharmacists

25 Potential for More 38 Legislation Other legislation includes: 7 day prescribing limit MAPS mandate Develop prescription drug education curriculum in schools Greater patient education requirements Greater provider sanctions

26 For Practioners: Taking Steps Now and Going Forward

27 Screening Tools 27 Increasingly recognized and further developed Separate screening tools for specific populations (e.g, Youth, Justice-involved)

28 Screening and Brief Intervention in Primary Care Settings Ask: Screen and Assess Risk, with follow up Brief Intervention Advise: Provide direct personal advice about substance use Assess: Evaluate the patient s willingness to quit or reduce use Assist: Help interested patients develop a treatment plan Arrange: Help patient arrange follow up appointment if desired Amaza et al 2015, ASAM

29 SBIRT Screening Brief Intervention Referral to treatment Primary Use for Alcohol and Tobacco Impact on other substance use requires further study

30 Substance Use Assessment and Treatment Services

31 ASAM Criteria: Moving away from the cookie cutter approach 31

32 ASAM Continuum of Care 32

33 Medication Assisted Treatments

34 Integrated Behavioral Health

35 Required SUD Services Funded and Administered by the PIHP Access Management System Screening, assessment and referral to appropriate treatment Receiving and placing referrals from the Department of Corrections Data System to track performance relative to National Outcome Measures Prevention Data System To capture number of persons served by evidence-based practices and population type, i.e., universal, selective and indicated populations.

36 Required Treatment Services The PIHP must assure use of a standardized assessment process, including the American Society of Addiction Medicine (ASAM) Patient Placement Criteria, to determine clinical eligibility for services based on medical necessity. Treatment services at all levels: outpatient, case management, residential Inclusion of peer recovery supports and access to MAT

37 STR Grant 37

38 STR Grant 31 The MDHHS applied for and received a $16M State Targeted Response to the Opioid Crisis Grant from SAMHSA The grant is a two year grant and grant activity it expected this fiscal year The purpose of the Michigan Opioid STR project is to increase access to treatment and reduce unmet treatment need; and reduce opioid overdose related deaths through the provision of prevention, treatment and recovery activities for Opioid Use Disorders (OUDs)

39 STR Grant:Highlights 32 To achieve our purpose for the project, MDHHS will: Improve the state infrastructure for individuals with an OUD; Train PIHP and provider administration on infrastructure improvements, and train provider staff on evidence based interventions and fidelity measures; Implement evidence based prevention and treatment interventions with accompanying fidelity instruments to ensure that the quality of the intervention is consistent across the provider network; Improve access to psychiatric services and psychotropic medications to individuals with an OUD;

40 STR Grant 33 Expand the availability and use of specially trained peers for MAT and drug free programming; Expand outreach and engagement activities to primary care and law enforcement sites; Increase supports to the prisoner re-entry population with an OUD; Expand the use of peers in emergency departments and primary care settings; Expand overdose education and naloxone distribution; and Disseminate a statewide media campaign for the purpose of public education.

41 STR Grant 34 The Michigan Opioid STR initiative will: Improve awareness of the risks associated with using opioid based medications, as well as illegal opioids; Increase the availability of prevention focused evidence based practices for individuals considered to be part of the selected or indicated portion of the population; Educate physicians on the CDC Prescriber Guidelines for responsible opioid prescribing; Increase access to Medication Assisted Treatment, withdrawal management, and residential treatment services for individuals with OUDs

42 STR Grant 35 Increase availability of treatment and recovery support services to individuals with OUDs, improve the quality of services for individuals with OUDs; Increase treatment and support services available to individuals re-entering the community from prison; and Revise policy and contractual language to reflect standards of care as identified in Michigan s MAT Guidelines for OUDs

43 43 a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMHSA 2014) E.G., SYMPTOM RESOLUTION, SOBRIETY, REDUCED RECIDIVISM, SOCIAL CONNECTEDNESS, EMPLOYMENT, EDUCATION, INDEPENDENT LIVING, SELF-RELIANCE

44 Lessons and Opportunities No one system or agency has the resources to meet all the needs of their clients. Service systems need to be aligned with what we know is true. Addiction is a chronic illness. Healthy communities help to sustain recovery and promote wellness for all.

45 Websites and Resources SAMHSA PCSS- Provider Clinical Support Services for Opioid Therapies - NIDA AAAP ASAM APA-

46 Resource and Contact Information Michigan Department of Health and Human Services, Office of Recovery Oriented Systems of Care at